Behavioural insights for improving resident decision making

Dr Barbara Fasolo Associate Professor Behavioural Science | Head of Behavioural Research Lab b.fasolo@lse.ac.uk

A talk prepared for the LGA – 12 March 2019 Nudges for social good – using behavioural insights in local government

Thanks to Grace Abel & Umar Taj What’s she like? We cannot change, or improve, residents’ decisions unless we know their decision mindware (how, and why they decide, or not) Human “decision mind-ware” is made of 2 systems designed to see the waitress smiling, first.

**SYSTEM 1**

*FAST!* Automatic Effortless Avoids too much thinking Loss averse Confused by info Forgets own values, long term goals Biased

**SYSTEM 2**

... slow ... deliberate .. Reads all information ... balancing losses and gains) ...remembers deep, long term goals Aware of biases

Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

© Dr Barbara Fasolo What’s the difference between nudging behaviour vs decision?

“Behaviour”

- normally a binary action (“I recycle or not”)
- well-known but not appealing (e.g. I know recycling means using a recycling sack or bank, but my habit is not to recycle).
- Nudging behaviour is about breaking habits, or creating new.

“Decision” (choice)

- many possible options (often more than 2 (“I choose a payment method to pay for rent arrears”))
- some options are new and need to be discovered by new information
- Nudging decisions is also about creating informed decision-making and educating ‘conversations’ (I chose X because...) The fundamental conflict for all of us who help others decide better

How others decide

How we wish others to decide

© Dr Barbara Fasolo Most decision helpers are optimistic

Citizens choose by System 1

But we offer choice for System 2 Decision helpers need to be realistic

offer choice architecture for System 1 Boyce, Dixon, Fasolo and Reutskaja (2010)

offer training For System 2 Fasolo & Taj 2019 Case: Helping to choose a high-quality hospital for elective surgery

What do you think residents care most about when choosing a hospital online? Hospital Choice was offered for System 2

We are not primed by the postcode, discount distance and choose by quality.

We are not overloaded by choice, have the time and resources to compare all 365 hospitals.

We are not afraid or stressed by the statistics.

We can understand numbers, invert scales, combine conflicting information, map indicators to our preferences, scroll down… Which Choice Architecture could...

- Increase # residents choosing Best Quality Hospital

  - (Government)

- Improve transparency, *informed* choice (taking into account diff't age, numeracy etc)

  - (King’s Fund)

- Decrease Effort for online user

  - (NHS choices team) The 3 stage project (for your later reference)

Focus Groups

- simpler and more consistent format of data;
- clearer and more consistent definitions of indicators;
- more balanced scorecard

Phase 1 5 choice architectures Effect of designs on:

- a) Choice outcomes (Prop People choosing best)
- b) Awareness of information
- c) Post-choice perceptions
- d) Information search (heatmaps)

Phase 2 2 architectures Any long-lasting effect of Phase 1 on subsequent choice and choice perceptions?

March 2009 44 people

January 2010 1168 valid participants

February 2010 744 valid participants

Dr Barbara Fasolo © Dr Barbara Fasolo Before nudging a decision, structure it!

Create “Choice Menus”:

2-5 Options (e.g. hospitals)

2-3 Clusters of Criteria

- First the most important that is forgotten

- Last the one that people overweigh/think most about

- Easy labels+checks + numbers Before implementing a choice architecture:

Consider Decision Mindware,

Design Choice (Not information) Architectures for System 1

Test them before choosing the one to implement (here, just 4)

1. Best first, Sort by Quality

Best Quality is First Active Choice Required 2. Opt-out Default (Highlight the best overall on all the criteria and set as opt-out default)

Same Scorecard as Sort-by-Quality

Best is highlighted pre-selected 3. Sort by distance, best in the ‘hotspot’

Best is 4th (away from edge and close to middle). Active choice required

Scorecard Pre-sorted by Distance (Quality not Mentioned) 4. Preference Articulation (list all objectives that are relevant and ask to rank them by own preferences)

...No Hospital is excellent across all indicators... You will need to make trade-offs...

The first indicator tells you how good the quality is... Numbers greater than 100 mean...

Rank all indicators from 1 (most important) to 9 (least important to you)

Then Scorecard (same as Best-in-Hotspot) When did most residents choose the highest quality hospital?

Best First? Opt Out Default? Hotspot? Preference Articulation? Prop ‘best quality hospitals’ choices

| Condition | Number of Observations | Proportion of best choices | |--------------------|-------------------------|----------------------------| | Default | 214 | 0.44 | | Best-First | 254 | 0.35 | | Best-In-Hotspot | 256 | 0.52 | | Preference | 219 | 0.48 |

(Reutskaja & Fasolo, 2013) When were residents making most informed choices?

With opt-out default

When preferences are asked Going back to your decision, can you...

1. Present your residents a simple menu/scorecard laying out 2-5 options available?
2. Highlight the option recommended?
3. Include the do-nothing/no-decide option (as choosing not to choose is a choice!)?
4. Include a checklist of objectives?
5. Ask to interact and rate these objectives by importance?

Thank you, and keep in touch: b.fasolo@lse.ac.uk